Stream: Medication
Topic: MedicationUsage.status = unknown
Grahame Grieve (Dec 20 2021 at 23:45):
I see that this has been removed. So the status can't be unknown, and there's no logical default value for legacy records? What's the intent here, and shouldn't this be discussed somewhere in the resource definition?
Grahame Grieve (Dec 20 2021 at 23:46):
also, the documentation sill uses 'statement' liberally. But perhaps that should stay that way so it's easy to change it back ;-)
Grahame Grieve (Dec 20 2021 at 23:47):
what I miss from earlier versions is the ability to say 'not-taken' explicitly. how would that be recorded now?
Melva Peters (Dec 21 2021 at 02:01):
We changed this based on FHIR-32060 which was submitted by Lloyd. https://jira.hl7.org/browse/FHIR-32060
Melva Peters (Dec 21 2021 at 02:02):
You can use MedicationUsage.adherence = not-taking to say that they are not taking explicitly.
Grahame Grieve (Dec 21 2021 at 02:42):
well, I think it might be useful to mention the presumption of accuracy somewhere
Grahame Grieve (Dec 21 2021 at 02:43):
and I feel as though adherence = not-taking is slightly skewed because it assumes that there is an instruction to take it, and their might not have been.
It's routine for people to get asked 'are you taking X' - that's a proper use of MedicationUsage, right?
Grahame Grieve (Dec 21 2021 at 02:47):
the example https://hl7.org/fhir/5.0.0-snapshot1/medicationusageexample2.json.html muddies the water quite a bit by being weirdly specific about the medication that's not being taken. (is some other dose being taken instead?) and by not including an adherence, and hiding the 'not-taking' bit in a non-processible text
Morten Ernebjerg (Dec 21 2021 at 13:22):
I agree with @Grahame Grieve on the use for recording "not taking this med". As discussed in this thread (which has a different title, looks like I accidentally posted a new question in an existing thread!), the "not-taking" examples are actually incorrect in both R4 and the newest build (this has been captured in JIRA #FHIR-34437). A @Jean Duteau argued in that thread, adherence "not-taking" should be the correct code for this example. But like Grahame, thinking about it know I also feel this is slightly misleading if it captures a response to a question like "Are you taking medication X?" - "not-taking" under adherence does sort of give the impression that the patient is ignoring advice given, although that is not implied at all by the question.
For comparison: For conditions, the spec guidance is to not use Condition to capture the fact that a patient does not have condition Y (unless it was previously believed to be the case) and instead use Questionnaire or Observation. Have similar approaches been considered or used for "not taking X" for meds?
Jose Costa Teixeira (Dec 21 2021 at 18:37):
I do not think 'not taking' is a good value for adherence.
Jose Costa Teixeira (Dec 21 2021 at 18:38):
"not taking as ordered" is completely different from "not taking, as ordered". And "not taking regardless of order"
Jose Costa Teixeira (Dec 21 2021 at 18:40):
@Morten Ernebjerg I think the resource MedicationStatement acts as an observation in that sense - someone is noting/asserting that the patient is (not) taking a med
Morten Ernebjerg (Dec 22 2021 at 11:43):
@Jose Costa Teixeira I guess the question then becomes if there is a better way to represent "plain not taking" (no implications about instructions) with MedicationStat/Usage.
Jose Costa Teixeira (Dec 22 2021 at 11:45):
I think that should be the core aspect of MedStatement
Jose Costa Teixeira (Dec 22 2021 at 11:46):
I.e. focus on whether it's being taken or not
Jose Costa Teixeira (Dec 22 2021 at 11:46):
The adherence is not the main statement imo. Adherence can be an inference or assertion by someone else
Lloyd McKenzie (Dec 22 2021 at 22:48):
Adherence is always with respect to an order. A patient might be not taking a medication - and that fully compliant with one order and non-compliant with a different order.
Grahame Grieve (Dec 24 2021 at 00:33):
that's my mother in law. GP counts her as adherent, and her specialist counts her as not. I'm really looking forward to Australian trying to create a reconciled medications record ;-)
Last updated: Apr 12 2022 at 19:14 UTC
